Pre-Auth Check
Services Requiring Prior Authorization – Oregon/Washington
Please confirm the member's plan and group before choosing from the list below.
Providers should refer to the member's Evidence of Coverage (EOC) or Certificate of Insurance (COI) to determine exclusions, limitations and benefit maximums that may apply to a particular procedure, medication, service, or supply.
Refer to the Pharmacy section of the website for information regarding prescription authorization requirements.
Medicare providers: Use our tool to see if a pre-authorization is needed. It's quick and easy. If an authorization is needed, you can log into the secure provider portal below and submit it there.
Commercial providers: Pre-Auth tool is expected to launch in the second half of 2020.
Updated Inpatient & Post-Acute Care Guidelines for Wellcare By Health Net Providers Through 2/28/22
To support increased access to care during the COVID-19 pandemic, Wellcare By Health Net will process all inpatient and post-acute care requests according to the below guidelines through 2/14/22:
| LOB | Long Term Acute Care Hospital | DME under $500 | SNF | HH | Discharge Rx | Review Date/End Date |
| Wellcare By Health Net | No PA required | No change | No PA required, SNF to notify health plan of admission | No change | No change | February 28, 2022 |
Login
If you are a contracted Health Net provider, you can register now. If you are a non-contracted provider, you will be able to register after you submit your first claim.
Once you have created an account, you can use the Health Net provider portal to:
- Verify member eligibility
- Manage claims
- Manage authorizations
- View patient list
- Login/Register
Prior Authorization Requirements
- Commercial - Oregon (PDF)
- EPO
- Point of Service
- PPO
- CommunityCare
- Medicare Advantage - Oregon (PDF)
- Medicare Advantage HMO
- Medicare Advantage PPO
- Washington PPO (PDF)